peggy@manual-medicine.com
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This is both the application and contact form for: Advanced Manual Medicine and Peggy Daugherty ND CMT Please fill out as many fields as apply to your needs.
E-mail:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Country:
ZIP/Postal::
Phone:
Birthplace:
Birthdate:
Citizenship:
Occupation:
Are you interested in therapy or education ? If educationl please list educational experience, degrees, certifications, occupation and life experience relevant to your training interest:
If you are interested in therapy, please state your individual reasons and need for treatment. Short term therapy is also available. List your injury history and treatments you have already experienced. Are you currently in a chronic pain pattern?
Please check the programs you are interested in:
PROGRAM #1: Integrative Neuromuscular Therapy
PROGRAM #2: Integrative Cranial Therapy
PROGRAM #3: Long-Term Intensive Therapy